Health Insurance Coverage Disruptions Tied to Higher Mortality Risks

Health insurance coverage disruptions were associated with higher mortality risks for people with private and public insurance, a JAMA Health Forum study found.

Health insurance coverage is typically linked to better access to care and health outcomes. Conversely, experiencing gaps in healthcare coverage may be tied to a lack of a usual care source and delaying or forgoing care due to costs.

Researchers used data from the 2000 to 2018 National Health Interview Survey (NHIS) to determine the association between health insurance coverage disruption and mortality risk among publicly and privately insured adults aged 18 to 64.

The NHIS measured coverage disruption by asking, “In the past 12 months, was there any time when you did not have health insurance or coverage?”

The study sample included 246,622 adults with private insurance and 47,473 adults with public insurance. Almost 5 percent of privately insured individuals reported a previous coverage disruption compared to 12.8 percent of publicly insured adults.

Almost 10,000 privately insured adults (3.93 percent) died during the study period, while 3,590 adults with public insurance died (7.56 percent).

Researchers found that among adults with private coverage, health insurance coverage disruptions were associated with higher mortality risk compared with continuous coverage. In the adjusted analysis of the full sample, the weighted hazard ratio was 1.63, and the unweighted hazard ratio in the propensity score matched sample was 1.41.

Similarly, coverage disruptions were associated with a higher mortality risk for adults with public coverage. The hazard risk was 1.15 in the adjusted analysis of the full sample and 1.22 in the matched sample.

“These findings suggest that assessment of prior insurance coverage disruptions may be an important addition to social risk screening in clinical practice,” researchers wrote.

Recent policies and legislation have aimed to increase access to health insurance coverage and could potentially limit coverage disruptions. For example, the Affordable Care Act allowed states to expand Medicaid starting in 2014. Among the states that have not chosen this route, Medicaid expansion has been one of the main focuses for lawmakers.

According to the researchers, Medicaid expansion has been linked to reductions in coverage disruptions, better care access, and improved health outcomes.

Additionally, the Inflation Reduction Act, which the Biden Administration passed in October, extended marketplace subsidies through 2025, which may help limit disruption in private coverage. The extension allows continued access to premium tax credits for individuals and families with incomes between 100 percent and 400 percent of the federal poverty level.

Data from HealthCare.com revealed that one in five Americans received regular healthcare during the COVID-19 pandemic, which they attributed to increased access to health insurance stemming from the enhanced marketplace subsidies and Medicaid eligibility policies.